膝关节置换图解

《膝关节置换图解》由会员上传分享，免费在线阅读，更多相关内容在教育资源-天天文库。

1、膝关节置换图解（1）  A76-year-oldwomanpresentedwithbilateralkneepain,leftworsethanright.Pre-operativeradiographsoftheleftkneeshowsevere,end-stageosteoarthritis.Theradiographichallmarksofosteoarthritisare:jointspacenarrowing,sclerosisofthesubchondralbone,osteophyteformationandeventuallycysticchange

2、sintheadjacentbone患者，女，76岁，主诉双膝疼痛，左侧为重。术前X线（左侧）示：骨性关节炎，关节间隙变窄，软骨硬化，骨赘形成以及软骨下骨囊性改变。  Standing"alignmentviews"areusedtodeterminethepatient'sweightbearingandmechanicalaxis.ThetechnicalgoalsofTotalKneeArthroplastyincludere-establishingthepatientsmechanicalaxisandrestoringthejointline.Oftentim

3、es,patientswillhavedevelopedsevere"varus"deformity(bowedlegs)orlesscommonly,"valgusdeformity(knockkneed).站立位通常用于决定患者负重和力线，TKA技术目标包括重建患者下肢机械轴线和恢复关节功能。通常，患者都有严重内翻或外翻（少见）。 Afterasterileprep,thelimbisdraped,landmarksareidentifiedandthemid-linekneeincisionisplannedunlesspatientshaveoldscarswhi

4、charenotcompatiblewiththisstandardincision经过一系列准备以后，下肢铺单贴膜，标记前正中切口皮缘，除非患者有疤痕不宜采用标准切口。  Thelegisexsanguinatedandatourniquetisusedtomaintainhemostasisthroughoutthecase.用下肢驱血带驱血，保持整个手术过程清晰。  Oncetheincisionismade,thequadricepstendon,thepatellaandthepatellartendonareidentified.Amedialpara-pat

5、ellararthrotomyismadeandthesofttissuesareelevatedfromthetibia.Greatcaremustbetakennottostriptomuchmediallyorlaterallyasthismayresultindisruptionofthemedialcollateralligamentorthepatellartendon,respectfully.Botharedisastrouscomplications.切开皮肤，显露股四头肌腱，髌骨，髌腱。从髌骨内侧缘（保留0.5cm软组织以利用缝合）切开软组织致胫骨，注

6、意不要向内侧或外侧剥离过多，以防损伤内侧副韧带或髌韧带，以免引起严重并发症。  Thepatellaandpatellartendonarereleasedfromtheunderlyingfatpadandothersofttissuessothepatellamaybeevertedlaterallytoexposethedistalfemurandproximaltibia.分离髌骨和髌韧带下方的脂肪垫及其他软组织，以便髌骨向外翻，以显露股骨远端和胫骨近端。  Afterthepatellaandtendonareeverted(underrakeinphoto),

7、remainingcapsulartissuesarereleased.Thepatellar-femoralligamentabovetheclampisabouttobedivided.把髌骨和髌韧带翻向一侧后，清除剩余软组织，分离髌股韧带（下图弯钳上方组织）  Onlyasinglecutismadetopreparethetibia.Anextramedullaryalignmentguideisplacedandsecuredwithpinsintheproximaltibia.Thisguideisusedtore